Pilates was originally developed by Joseph Pilates in the 1920's. It is a conditioning exercise program that targets the deep postural muscles of the abdomen and spine to improve overall core stability and posture.
Clinical pilates consists of a series of exercises in various different body positions which have been adapted by physiotherapists to make them more suitable for use with patients groups. Essentially I prescribe exercises based on an individuals’ clinical need, taking into consideration factors such as their injury or pain, their posture, areas of muscle weakness or over activity, and movement dissociation.
I teach clinical pilates underpinned by the Australian Physiotherapy and Pilates Institute. The APPI has modified the original 34 Pilates matwork exercises to incorporate the recent research on lumbar instability, muscle imbalance and adverse neural tension. This makes the exercises highly versatile and accessible to a broad range of individuals, of any age and any physical ability.
I feel that there is a large emphasis on not only what the exercise is, but also how the exercise is performed, i.e. having the correct technique; using the correct muscles; and utilising the appropriate amount of energy in order to work effectively and efficiently. This makes clinical pilates a gentle form of exercise and ensures optimal gains whilst minimising the likelihood of injury aggravation. However, this doesn’t mean that I can’t put you through your paces if that’s what you are after!
Key benefits of Clinical Pilates include retraining:
* Neutral lumbo-pelvic alignment and activation of the key lumbo-pelvic stabilising muscles
* Correct ribcage/thoracic alignment
* Scapulo-thoracic stabilisation
* Deep neck flexor retraining to stabilise the cervical spine
* Spinal mobility
* Flexibility of the key trunk and lower limb muscles groups
* Body awareness/postural awareness.
* Normal movement patterns, which is especially important in the case of injury or pain as this aids rehabilitation & reduces the risk of re-injury
1. Concentration: Focus on correct performance of each Pilates exercise and the specific muscles involved.
2. Centering: Focus on achieving neutral spine and activating the core stabilising muscles (pelvic floor and transversus abdominus) to support the lower back and pelvis
3. Control: Maintain optimal posture and control with all movements.
4. Flowing Movement: Work smoothly and efficiently with all movements.
5. Precision: Perform each Pilates exercise with attention to detail to ensure correct technique.
6. Breathing: Maintain relaxed, normal breathing throughout all pilates exercises. Do not hold your breath.
Clinical Pilates & Lower Back Pain
Recent research advocates the retraining of the deep stabilising muscles for patients with low back pain. Clinical pilates focuses on the retraining and recruitment of these stabilising muscles (core stability) as well as improving posture, strength and flexibility. Pilates can therefore help to prevent the recurrence of back pain in combination with correct back care and advice, and gentle aerobic activity.
I have lots of experience working with patients of all ages (children to the elderly) who present with back pain, acute and chronic. I have found a combined approach of clinical pilates, hands-on physiotherapy (especially myofascial release techniques) and advice/support to be a very effective program of treatment. In many cases I have worked with people who have had back pain for many many years, in some cases 20+ years! I couldn’t fix them over night but we worked hard together and had excellent results where people can feel better than ever, but it does take effort on both parts. So don’t be put off if you have had your pain for a long time.
Do I have to be pain-free/injury-free before I can start?
No. Many patients find that pilates is a useful form of exercise, helping them to return to their normal day to day activities/hobbies/sports following pain or injury.
What does it involve?
I would need to ask a few questions about your health and well-being, and what has motivated you to come see me. I will assess your posture and look at certain aspects of your joint/spinal mobility and muscle strength. I will work with you to address your specific needs and tailor a program to your individual requirements.
If you have any additional queries please not hesitate to contact us.
1/ Adequate Clothing: in this country especially you can never be too sure of what the weather will throw at you so be prepared. Invest in a good waterproof as this will make the best of the worst and some good arm and knee/leg warmers for those cooler morning starts that develop into a warm day. Don’t forget the toes either as they do take the brunt of cool and damp weather so some light shoe or toe covers.
2/ Bike Equipment: ensure your bike is regularly serviced so a mechanical doesn’t spoil your ride, or even worse your race. Keep moving parts clean and lubricated and check for wear and tear in the chain, rear cassette and chain rings. Make sure the brakes work well and you have some spare pads to change when required. A good saddle is also key. They are like shoes, some fit, some don’t so do try a few before settling on one. Most good bike shops will let you do this. ALWAYS wear a helmet, it may just save your life one day. Don’t have it hanging on the bars, that only prevents scratches to the bike, not to your head and brain.
3/ Be Seen: yes darker colours absorb the sun keeping you warm but they are difficult to see so try and brighten it up with some light arm and ankle bands or buy clothing that is lighter, even with bright stripes or something similar. If you’re riding on duller days or early morning/late evenings, ensure you have a set of bright lights that work.
4/ Hydrate: start the ride well hydrated and aim to keep it this way. Generally 750-1000ml per hour especially now it’s getting warmer. As little as a 2% drop in hydration can reduce your mental and physical performance by 10-30% and don’t rely on thirst as you’re already dehydrated. Keep sipping your fluid (water, electrolyte drink, juice) every 10-15mins or so and aim to pee pale yellow! Unfortunately great coffee doesn’t count so offset with a glass of water with it on the coffee stop.
5/ Fuel: you should be well fuelled before each ride and this starts during your previous ride/training session so don’t “wait till I’m home” as this will not only make you more likely to overeat when you’re done but also impact on following training sessions. Aim to have something decent about an hour before you start e.g. porridge, yogurt and fruit with same cereal, wholegrain toast with nut butters, smoothie made with yogurt/milk fruit and nuts so it has time to digest and provide you with energy. Avoid anything 20-30minutes before as you’ll go straight to burning this off and into the sugar stores rather than the fat stores which may make you need more fuel during the ride, plus if you’re trying to lean down a little, it’ll impact on that.
If the session is less than one hour you should be fine with just water if you’re fuelled. If it is longer then start taking a carbohydrate drink/food at about 1-1 1/2hours and have small amounts but regularly so as to avoid stomach discomfort. What you have is very personal but sports drinks, cordial with small amount of salt, banana, fruit bread with honey/jam nut butter sandwiches, Jaffa cakes or muesli bars. If it is an intense session you may just stick with water and a sports drink as it’s easier to digest and you may need more than just water to keep energy and effort levels up.
After training try and have a snack especially if you are not eating for some time so fruit smoothie, milkshake, banana and yogurt, pancake with honey and nut butter and obviously fluid. Then within two hours try and have a meal that includes protein, carbohydrate and essential fats so grilled fish or chicken with sweet potatoes and salad, chick pea stir fry or bean and vegetable soup with bread.
Snack between meals to keep energy levels up especially if you’re training more than you have been and again this will help prevent overeating at meal times and energy levels up for work and training. Ideas are a Handful of nuts, seeds and dried fruit, fruit and yogurt, crumpets with nut butters, fruit breads, granola with yogurt, muesli bars etc. Try to avoid the biscuit tin and chocolate but everything in moderation! These will have a slightly adverse effect on your blood sugar giving you an initial high and then a slump leaving you craving yet more sugar.
The use of caffeine is becoming increasingly popular and it has been proven to enhance performance but beware of its effect on heart rate as some people are very sensitive making the heart give extra beats which may be a little alarming. Most caffeinated drinks that people tend to use are the energy drinks but these also contain high amounts of sugar so if you have one just before you set off be mindful of the effects on blood sugar and the fuel you will initially be burning. Stick to black coffee/tea with no sugar if you are leaving it until the last 10-15minutes.
Small amounts of caffeine towards the second half of a long session do help to mobilise the fat stores thus providing you with energy when the glycogen stores are running out and this practice is used a lot in endurance events. It also gives you a lift in and reduces effort level.
One thing to remember, play around with what you have and when so you know what you can tolerate before the event. Do not try anything new during the event because it’s there unless you are desperate as it may impact on the rest of the race. If it is a hilly event, aim to eat after climbing the hill, not just before or during as you’ll be working harder and thus it’ll be more difficult to digest. Wait until you’re at the top.
Most importantly is to practice what you want to eat, have a look at what is provided during the event and try those so you know what you can have and to plan how much you need. A general equation is 1g of carbohydrate (liquid or solid) let kg of bodyweight per hour but this does vary. Another way is about 250-400kcal per hour depending on intensity of effort and body size. Again, it is all about practice to see what you need and can tolerate.
6/ Skills, drills and technique: do spend time on how to handle the bike so as to be safer and also reduce losing time in any races/events. Simple things like practice taking water bottle in and out, reaching into pockets for food and eating on the go. Plan a specific drills session where you make a mini circuit that involves tight corners and practice going in both directions. As a general rule, if turning right, left foot is pressing into the left pedal and leg straight, the left hand is pressing into the left handle bars and straightish. The right leg is bent as is the arm with little weight on it. The extent of both is corner angle dependant. Practice taking the right line so you slow going into it but can speed away as you come out of the corner. Think about gearing too so you will need to change down into easier gears going in so you do not grind a big gear, thus losing momentum and speed coming out of the turn. Then there is descending. Again practice. Similar rules apply as to cornering.
7/ Train to race/complete the event: once you enter a key event/race have a look at the profile and try to train on as similar terrain as possible i.e. if it is flat train mainly on the flat, if it’s hilly train hilly and do try and be in the position you hope to race in as much as possible so if you plan to be on the drops or aero bars then be in that position in training so you train the muscles in that position. There is no point doing most of your training on the hoods to then expect yourself to do well on aero bars for several hours. Not only will you feel uncomfortable but you and your muscles will not be efficient and strong in this position as it is relatively new for you. Make exceptions for long club rides but key sessions do try and be in the race position as much as possible, or at least when you’re doing efforts/intervals.
Include strength work, so over gear hill reps in the saddle.e.g 6x5min at 65-70rpm in big gear. If you can’t find a hill long enough do somewhere that has an incline or on the flat but put in the biggest gear. Then have a few mins easy or descend freely with little effort focusing on technique and bike handling.
If you’re racing more road races and criteriums then include power surge work.e.g 10x10 sec out the saddle max effort with 1.50 easy. Spin for 5mins and repeat 2-3times. In group rides include some chain gang work going through and off work and understanding where you need to be to get the most shelter and in what side the through and offs should be in regards to wind direction and corners.
For long endurance races, include longer and longer intervals at race pace effort depending on the distance e.g. in a 3hour ride have 30min warm up then for the next 2hours include 10-30mins at race pace with 5mins spin between and do for the remainder of the ride but do a decent warm down.
8/ Functional fitness: this is the bit everyone forgets. It’s the small bits that count in enhancing performance and reducing injury risk to ensure you are using the correct muscles as the correct time and they are strong enough to maintain their work. People may have heard of “core stability” but it is more of a functional stability according to what you are doing and aiming to achieve, so yes it is about the lower transabdominal muscles but also about your gluteal (bum), lower back and shoulders and how they connect together to give you a stable platform to work from.
9/ Flexibility: this is very important. A tight muscle is a weak muscle so do spend time on stretching after your ride. Doesn’t have to be immediately but definitely that day. Focus on hip flexor and quadriceps and gluteal but do not forget hamstrings, calves, neck, shoulders and back. Hold each stretch for 30sec and ideally do 2-3times. A foam roller is also good for self massage before stretching as is finding a good yoga class to enhance your flexibility, stability and breathing. Many sports people are turning to yoga to enhance their performance and reduce injury risk.
10/ Bike fit: this is imperative in reducing injury, enhancing performance and maximising your efficiency and comfort. When you buy a bike you should have it fitted to you at the shop and this is great but you then having it looked at closer, so it fits you and your biomechanics, flexibility, stability and functional stability together will give you the perfect ride. Here at Physio Impulse our Bike fitter and Osteopath Jasper will do exactly that and offer advice re exercises, stretches and training so as to help you achieve your goals and limit injury.
Physioimpulse Chartered Physiotherapists